CommonWell Mobilizes to Support Payer Interoperability Compliance

October 22, 2020 - CommonWell Health Alliance announced that it is expanding its interoperability services, a move which could support payers struggling with interoperability compliance related to the new CMS rule.

“We see this new collaboration and service offering as the next step towards helping us collectively achieve national interoperability and the quadruple aim,” said Paul Wilder, executive director of CommonWell Health Alliance.

CommonWell Health Alliance’s membership consists of health care in over 20 care settings and technology organizations. Through CommonWell, these entities collaborate to make health data available to providers at an affordable rate. The organization has facilitated the exchange of over 790 million health documents.

“Despite strides made in electronic clinical data exchange, existing payments and operations processes providing access to protected health information (PHI) remain archaic, predominantly manual, expensive, error-prone and time consuming,” the press release charged.

In order to overcome these common barriers to protected health information data exchange, CommonWell has partnered with a data exchange technology company. The new partnership will enable payers, record locator vendors, and other users to engage in an automated exchange of data requests.

The collaboration will require building technology to support these data requests. The organization will pilot the new record retrieval process using four CommonWell Service Adopters.

This announcement comes as payers are preparing to comply with the new interoperability standards which were originally set to go into effect in January 2021. Due to the coronavirus pandemic, however, the agency postponed the deadline until July 2021.

CMS and the Office of the National Coordinator finalized the new rules in early March, shortly before the coronavirus pandemic outbreak took hold in the US.

“In today’s digital age, our health system’s data sharing capacity shouldn’t be mired in the stone age,” CMS Administrator Seema Verma said when the agencies finalized the rule. 

“Unfortunately, data silos continue to fragment care, burden patients, and providers, and drive up costs through repeat tests. Thanks to the leadership of President Trump, these rules begin a new chapter by requiring insurance plans to share health data with their patients in a format suitable for their phones or other device of their choice. We are holding payers to a higher standard while protecting patient privacy through secure access to their health information. Patients can expect improved quality and better outcomes at a lower cost.”

The new rule is adjoined to the CMS MyHealthEData initiative in order to support the safe flow of healthcare data between public payer entities.

Specifically, the rule requires that healthcare organizations have an application programming interface (API) to enable third-party apps and vendors to share and retrieve patient data and to pass data between public payers—such as Medicare and Medicaid.

America’s Health Insurance Plans (AHIP) has expressed concern over the rule in the past, but now that it will go into effect, the organization has pivoted to guide payers through the process.

First, the organization stated that payers should have three overarching objectives when they prepare to comply with the new rule, Matt Eyles, president and chief executive officer of AHIP, wrote in a statement. They must seek to protect patient privacy, reduce healthcare spending, and incorporate the personalization that members demand and expect.

Second, AHIP outlined several steps that payers would have to take to conform to this new policy.

Perhaps the most significant shift is that payers will need to be able to gather provider payer amount, patient cost-sharing, and clinical data and the data must be shareable and secure. This means that payers will need to develop APIs.

That is where CommonWell’s solution comes into play. CommonWell—similar to other organizations and associations such as CAQH—is working on formulating a network that will support data-sharing processes. With networks already in place for sharing data at this level, payers and vendors can more easily connect with one another.

“Improving data exchange of Payment and Health Care Operations is critical, particularly as we look at ways to help our health care system do more with less time and resources,” said Janine Akers, founder and chief executive officer of CommonWell’s partner, DataFile Exchange. “We’re well-positioned to partner with CommonWell in its effort to help patients, providers and payers benefit from these next-level interoperability services.”